Future of Medicine: Are providers ready for telemedicine?

By their very nature of being community-based, hospitals have long faced difficulties in expanding their potential customer base.

Of course, in markets with multiple hospitals, growing patient volume has resulted from stealing market share from their competition. Unlike businesses selling more tangible products, there wasn’t much a hospital could sell online or by phone.

The internet has changed all that, and new reports say hospitals will have to take advantage of telemedicine opportunities or soon be left behind. The latest comes from “The Future of Medicine,” a report released in October by the Jacobs Institute and funded by Delaware North Chairman Jeremy Jacobs and his family.

Written by a team of “futurist” technology inventors, investors and researchers, the report includes a section on how health care will migrate to virtual medicine in the next decade.

Hospitals and medical practices that figure out virtual medicine and patient flow will be able to scale and reach potential new customers around the world.

According to the report, those organizations that get a leg up on virtual medicine will be in a position to acquire the laggards. Merger and acquisition activity, it says, will increase significantly and then skyrocket as interoperability improves.

It also means that providers that don’t catch on soon will be vulnerable to competition from outside their existing markets.

Local health systems said they’re already putting programs in place to remain competitive. At Kaleida Health, that includes a telemedicine program that kicked off in recent months to connect cardiovascular specialists to patients at Olean General Hospital.

Dr. M. Hashmat Ashraf is chief of cardiothoracic surgery at the Gates Vascular Institute at Buffalo General Medical Center. He demonstrated the process by connecting to a volunteer via webcam, with a nurse checking her pulse, heart and lung sounds and for edema, as well as answering the types of questions a physician might ask a patient or family members.

Incorporating the technology into his practice has required a mindset shift, Ashraf said.

“With technology advancing in every field in life, you have to have an open mind,” he said. “It will also enable us to get to a broader market of patients so that we can help them wherever they are.”

Donald Boyd, executive vice president for business development and affiliations at Kaleida, said the health system has been keeping an eye on technological advancements. And Kaleida has been thoughtful in the best ways to introduce them to the system.

“We wanted to have early adopters and champions like Dr. Ashraf so we could be sure of the technology and make sure that the tools the physicians need are there,” he said. “We’re also concerned with adoption and would people be supportive of this, both patients and families.”

The technology is important to attract patients from outside the region and to improve access at hospitals outside the metro area with which Kaleida has affiliation deals. They reach up into northern Niagara County and down to the Pennsylvania border.

“As we look at all the work we’re doing with our affiliate hospitals and the people who have chosen to be part of our system, one of the things that has come up in those conversations is how we continue to improve access to care,” Boyd said.

Dr. David Martinke, chief medical officer of Catholic Medical Partners, said telemedicine is truly the paradigm of the future, using technology as a tool to help facilitate the diagnosis and treatment of patients.

And it can be used more extensively in settings such as home care or to manage patients with chronic conditions versus those with more acute or emergency situations.

Though telemedicine applications will help break down geographic and access barriers, it simply can’t replace in-person care. First, of course, there are limitations on what the physician can see. Second, and maybe more important, there’s the lack of connection that is established in a face-to-face environment, he said.

“I still think we have to start out with a primary relationship between the physician and a patient,” Martinke said. “I think the idea of a physician and patients totally interacting without any face-to-face encounter — like a doctor in India and a patient in America — is still a ways off.”

How patients or consumers adapt to the changes will depend heavily on generational acceptance. He said one only needs to consider how banking has changed to see what could happen in medicine.

“So often we go to an ATM or take a picture of a check. We don’t even have to go into a bank,” Martinke said. “People like our parents never didn’t go in, but our kids will never go in.”

On the hospital side of things, acceptance starts at the administrative level and with investments in the right technology.

Other challenges include reimbursement by government and private health care payers, credentialing and licensing for providers and buy-in from physicians who worry about whether payment for care provided electronically will be on par.

Michael Galang is senior vice president and chief information officer at Catholic Health.

“As you can imagine, there are many competing priorities because of the way health care is changing,” Galang said. “We have our smartphones and iPads so we can Skype or Facetime, but it’s not the same as being there. But you certainly get a sense it could proliferate into something of value.”